细菌性肝脓肿螺旋CT的征象分析

Spiral CT signs analysis of bacterial hepatic abscess

目的探讨细菌性肝脓肿螺旋CT的征象。方法回顾性分析39例资料完整并经手术或治疗后证实的细菌性肝脓肿的螺旋CT表现,包括临床、平扫、动态增强表现。结果临床特点发热或1个月内发热病史,血常规—白细胞增高;病灶单发24例,个病灶以上15例,病灶总数57个。平扫表现肝内低密度灶,边缘模糊或清晰,病灶内密度不均,可见环形带及分房样2改变;可伴气体、结石以及胸腔少量积液。增强表现a)动脉期表现低密度病灶周围肝组织强化明显,而病灶本身或边缘无明显强化或轻度强化;伴肝段一过性强化12例。)门静脉期表现()ba病灶呈不规则强化4例;()b环征(单、二、三环)例;()30c多房状征或花瓣征5例。c)延迟期表现病灶缩小或不变,水肿带消失或模糊,脓肿壁或分隔呈“持续强化征”。结论临床发热及白细胞增高和螺旋CT扫描病灶表现为病灶积气、动脉期无明显强化或轻度强化、门静脉期呈“环征”强化、延迟期呈“持续强化征”对细菌性肝脓肿的诊断及鉴别诊断有重要价值。

Objective To analyze the spiral CT signs of bacterial hepatic abscess(BHA).Methods The CT and clinical findings of 57 lesions in 39 cases with BHA were analyzed retrospectively.Results Clinical characteristic:the patients have fever now or since last month,or complicated with leukocytosis.The imaging features of plain CT were low-density lesions in the liver.It might show the “circular sign”,liquidizing necrotic area,gas,calculus within the lesion and pleural effusion.The imaging features of arterial phase were that the hepatic tissues around the lesions showed strong enhancement,but the lesions and lesion walls showed slight enhancement or not,showing the transient hepatic segmental enhancement in 12 cases.The imaging features of protal venous phase were (1) patchy enhancement sign in 4 cases;(2)circular target sign or circular sign in 30;(3)flower valve sign or multiloculated sign in 5.The imaging features of delayed phase were the lesions changed smaller or not and the edema belt disappeared or got vague;and the walls of lesions or the lesions showed continued enhancement sign.Conclusion Fever or leukocytosis,lesions with gas,slight enhancemet or not,circular target sign or circular sign and continued enhancement sign are very valuable for the diagnosis and differential diagnosis of BHA.